2) This program is supported by an educational grant from Jazz Pharmaceuticals & is intended for healthcare professionals. Accreditation statement & faculty disclosures are at https://t.co/Svtq9I6Kqb.
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
4a) Spasticity in #MultipleSclerosis is a common manifestation of CNS insult (an upper motor neuron sign). It causes disability via motor limitation, and through other manifestations: fatigue, pain, falls, sleep disturbances, . . .
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
5) In your practice, do you inquire about symptoms that suggest spasticity?
Challenge question. What is the prevalence of #spasticty in #MS at 10 years post MS onset?— MultipleSclerosis_CME (@ms_cme) September 20, 2022
7) Physical exam shows #muscle #hypertonicity more evident upon velocity-dependent passive limb movement and increased #tendon_reflexes to include #clonus. See a great 15-sec video of ankle clonus at 🔓https://t.co/5ZIyz0tHp8
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
9) It's important to always consider #spasticity. In addition to described symptoms affecting function, comfort, and #QOL, long term manifestations include permanent joint #contractures / deformities, #pressure_sores, and infections. How to go about managing it?
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
11) 2nd Step: refer to rehab medicine and/or #PhysicalTherapy for a personalized stretching and exercise program. I @DocforMS also find #yoga and #tai_chi useful in mild to moderate cases of #spasticity. pic.twitter.com/npNEnVUxbp
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
13) Question time: Of the following medications used to treat #spasticity, which one does not have a central mechanism of action and instead has a direct effect on muscles?
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
15) Next step is to consider pharmacological management of #spasticity. Options include #baclofen (oral and intrathecal), #tizanidine, #benzodiazepines, #dantrolene, #botulinum toxoid injections, and #cannabinoids. pic.twitter.com/5jGMvOeW6d
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
17) #Baclofen is a #GABA-B receptor agonist primarily in afferent fibers in the spinal cord. Oral used in mild to moderate spasticity but significant side effects (sedation) at higher doses might limit use. #Intrathecal form allows for better control in those cases. pic.twitter.com/PKc9hBwI8q
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
19) #Dantrolene exerts its action peripherally in the muscle, not in the CNS. Suppresses release of calcium from sarcoplasmic reticulum resulting in muscle relaxation. Side effects are drowsiness, weakness, fatigue. Monitor for #hepatotoxicity. pic.twitter.com/UCFyJSaK9i
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
21) #Botox injection can be used when one or at most few muscle groups drive most of the functional deficit related to spasticity. There is limitation on how much can be administered which makes it impractical for the common diffuse involvement in #MS. pic.twitter.com/u4mG6114gW
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
23) Use of #marijuana as a source of #cannabinoids for symptomatic treatment of some #MS manifestations can be challenging due to variability in concentration, quality and access, and inability to control precise dosing for titration and adjustment.
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
24b) For a nice review of the science of cannabis and brain health, see 🔓https://t.co/tUXKfp84pr
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
25b) Check out https://t.co/h529b8kFDJ from 🇬🇧.
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
27) Ongoing studies are evaluating #nabiximols efficacy for different #spasticity symptoms in MS.
For example, check out https://t.co/RXBhMgj0IY and https://t.co/Alx1YERQsX .— MultipleSclerosis_CME (@ms_cme) September 20, 2022
29) And CONGRATULATIONS! You just earned 0.5h CE/#CME. Go to https://t.co/aVRK7ClAu4 and claim your certificate! And follow us here for more #accredited #tweetorials from expert authors.
— MultipleSclerosis_CME (@ms_cme) September 20, 2022
